EVALUATION OF NEW ORAL ANTICOAGULENTS IN MANAGEMENT OF DEEP VEIN THROMBOSIS

Abstract

Background: Low molecular weight heparin (LMWH) and vitamin K antagonists (VKAs) have been considered the first line option for the prevention and treatment of venous thromboembolism (VTE) for several yearsafter decades during which warfarin was the only oral anticoagulation option; newer anticoagulants have the potential to change the management of coagulation disorders. The new oral anticoagulants (NOACs) differ from VKAs in their action mechanism because of direct inhibition of proteins of the coagulation cascade. They have more predictable pharmacokinetics leading to fixed and convenient dosing regimens and no need for routine monitoring, as well as in a rapid onset of action, and importantly, high efficacy and low risk of bleeding. Some of their limitations are the higher cost, limited monitoring (if needed, as only qualitative measures available) and the lack of a specific antidote. Objectives: To evaluate the efficacy and side effects of the new groups of oral anticoagulants in comparison to traditional oral anticoagulants in management of deep vein thrombosis. Patient and methods: This work was done over 50 patients, divided into 2 equal groups: Group I received oral rivaroxaban for 3 months, and group II received warfarin guided with INR measurement for 3 months. The following was done for all patients: Complete blood count, coagulation profile, liverfunction tests, kidney function tests and duplex scan. Results: Rivaroxaban (group I) included 9 males and 16 females with a mean age of 37.6 (27-60), and a mean body weight of 83.7± 16.3. Warfarin group II included 7 males and 18 females with a mean age of 37.9 (27-52), and a mean body weight of 84.2± 13. The main symptoms of our patients were leg pain in 86%, leg swelling in 78%, tenderness in 74%, redness/warmth in the leg in 34%, the main risk factors for DVT were hormonal contraceptive in 44%, immobilizations in 34%, hypercoagulability in 30%, operative history in 24%, history of orthopedic surgery in 22%, old age in 8%, with no statistical significant differences between the 2 arms of the study. Conclusion: Rivaroxaban have the advantage of more predictable anticoagulation, fewer drug interactions, and vascular outcomes compared with warfarin. New oral anticoagulants have shown to have a favorable balance between efficacy and safety compared with warfarin because recanalization occurred, with high percentage in new oral anticoagulants more than warfarin. Rivaroxaban has a rapid onset of anticoagulant that can be given in fixed doses without routine monitoring.